What is the management for a midshaft clavicle fracture in a newborn after spontaneous vaginal delivery (SVD) without shoulder dystocia?

Management of Neonatal Midshaft Clavicle Fracture After Uncomplicated SVD

Neonatal clavicle fractures require no active treatment beyond parental reassurance and pain management, as they heal spontaneously within 2-3 weeks without intervention or residual deformity. 1

Immediate Management

Diagnosis Confirmation

• Clinical examination may reveal a spongy feeling or crepitus on palpation of the clavicle 1
• Imaging studies should confirm the diagnosis if clinical suspicion exists 1
• Note that up to 40% of neonatal clavicle fractures remain undetected at hospital discharge 1

Initial Treatment Approach

• No immobilization is required - unlike older children and adults where sling use is standard 2, 3, neonatal clavicle fractures heal without any medical intervention 1
• The fracture will heal spontaneously without residual deformity 1

Pain Management

Implement multimodal analgesia with weight-based dosing: 4

• Acetaminophen (appropriate weight-based dosing)
• Ibuprofen (appropriate weight-based dosing)
• Use either medication alone or in combination as needed for comfort 4

Parent Education and Reassurance

Provide clear reassurance to parents that: 1

• Healing will occur naturally within 2-3 weeks without any intervention
• No residual deformity will result
• The infant can be handled normally with gentle care
• A callus (bony bump) may form during healing but will remodel over time

Monitoring for Complications

Instruct parents to seek immediate medical attention for: 4

• Skin changes suggesting vascular compromise (numbness, tingling, or weakness in the arm or hand)
• Fever or signs of infection
• Worsening swelling or discoloration

Important Clinical Caveat

Since this fracture occurred without shoulder dystocia, document this carefully: 1

• Clavicle fractures are most commonly associated with shoulder dystocia 1, 5
• Fractures without clear traumatic mechanism in infants under 24 months warrant consideration of non-accidental trauma 4
• However, birth-related clavicle fractures can occur even without documented shoulder dystocia 1
• Careful documentation is important from medico-legal aspects 1

Follow-up

• Routine follow-up is typically unnecessary given the benign natural history 1
• If parents remain concerned or symptoms persist beyond 2-3 weeks, clinical re-evaluation may be warranted